Session Information
Date: Sunday, November 13, 2016
Title: Vasculitis - Poster I: Large Vessel Vasculitis and Polymyalgia Rheumatica
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Case reports and series suggest that Takayasu’s arteritis (TA) can co-exist with various inflammatory disorders. Inflammatory bowel disease [(IBD; Crohn’s disease (CD) or ulcerative colitis (UC)] has been the most common association. We conducted a formal study to look specifically at the frequency of such inflammatory disorders in a large cohort of TA followed by a single tertiary center.
Methods: There were 226 (200 F/ 26 M) patients registered with a diagnosis of TA. Of these, 17 (8 %) had died and 15 (7 %) were lost to follow-up. The remaining 194 patients were called back at the outpatient clinic for an interview and for a physical examination. A standardized form sought whether the patient was also diagnosed as IBD, ankylosing spondylitis (AS), Behçet’s syndrome (BS), amyloidosis, uveitis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (pSS), Sjögren’s syndrome, psoriatic arthritis, inflammatory myositis, small vessel vasculitis, autoimmune/demyelinating or any other inflammatory disorder. In addition to the self-reported information, patient charts and all medical documentation available were used as a source of information.
Results: 153 (136 F/ 17 M) patients were studied. The mean age at the onset of symptoms was 31±11 years and at the time of TA diagnosis was 34 ± 12 years. Subclavian artery was the most common involved artery (83%), followed by common carotids (75%) and aorta (64%). Currently, while 25 (16%) patients were off treatment, 72 (47%) patients were using glucocorticoids, 47 (31%) azathioprine, 32 (21%) methotrexate and 44 (29%) biological agents. We identified in total 31 (20 %) patients with inflammatory diseases (IBD: n= 11; AS: n = 11; and BS: n = 9). Table shows their demographic characteristics. Among the remaining 122 patients, inflammatory back pain was present in 44 (36 %) recurrent oral ulcers were present in 19 (16%), erythema nodosum in 13 (11%), arthritis in 12 (10%), papulo-pustular lesions in 5 (4%), uveitis in 5 (4%) and genital ulcer in 1. It was noted that inflammatory back pain was mostly located on the dorsal area (n=40). Apart from these diseases, we also observed secondary amyloidosis (n=3), psoriasis (n=3), autoimmune hepatitis (n=2), RA (n=1) and morphea (n=1). None of the patient had SLE, Sjögren’s or myositis.
Conclusion: TA does co-occur with IBD, AS or BS in about 1/5 of the patients, at least in a hospital setting and without a clear temporal pattern. This could be due to the close association of TA with MHC class-1 diseases. In addition, the high prevalence of inflammatory back pain in the dorsal spine in TA needs further scrutiny.
Table. Demographic features of 31 TA patients with inflammatory bowel disease (IBD), ankylosing spondylitis (AS) or Behçet’s syndrome (BS)
|
Concomitant disease |
F/M |
Mean age at TA diagnosis (SD) |
Mean age at concomitant disease (SD) |
The time of TA diagnosis in relation to concomitant disease |
|
AS (n=11) |
9/2 |
31 ±8 |
27±11 |
TA preceded (n=6) AS preceded (n=5) |
|
IBD (n=11) |
10/1 |
33±9 |
31±9 |
Simultaneous (n=6) TA preceded (n=2) IBD preceded (n=3)
|
|
BS (n=9) |
7/2 |
35±13 |
32±13 |
Simultaneous (n=4) TA preceded (n=1) BS preceded (n=4)
|
To cite this abstract in AMA style:
Esatoglu SN, Celik AM, Ucar D, Celik AF, Ugurlu S, Hatemi G, Melikoglu M, Fresko I, Hamuryudan V, Ozdogan H, Yurdakul S, Yazici H, Seyahi E. Associated Inflammatory Diseases in Takayasu’s Arteritis: The Many Faces of a Disease [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/associated-inflammatory-diseases-in-takayasus-arteritis-the-many-faces-of-a-disease/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/associated-inflammatory-diseases-in-takayasus-arteritis-the-many-faces-of-a-disease/